Provider Demographics
NPI:1437212065
Name:CANNELLA, INGRID D (LPC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:D
Last Name:CANNELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:D
Other - Last Name:CANNELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2406 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4314
Mailing Address - Country:US
Mailing Address - Phone:318-792-3331
Mailing Address - Fax:318-484-6844
Practice Address - Street 1:2406 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4314
Practice Address - Country:US
Practice Address - Phone:318-792-3331
Practice Address - Fax:318-487-5184
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA695101YM0800X
LA1808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA83-0363493OtherEIN